Organization
WALMART INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 277-6348
Entity
Organization
Contact information
Practice address
583 COMMERCE DRIVE, SMELTERVILLE, ID 83868
(208) 783-2739
(208) 783-2825
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2138RP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2021949
PK
—
05
—
807691800
—
ID
Enumeration date
12/27/2006
Last updated
07/08/2025
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